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Utilization Review Manager Jobs in Madison, WI (NOW HIRING)

Imedica

Supervisor, Utilization Management

Madison, WI

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

More specifically, support the Manager, Utilization Management in relationship building within ... Accessible during workday to facilitate problem solving and resolution of case review issues and ...

Humana

Compliance UM Nurse (Wed - Sun)

Madison, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

  • Medical

  • Dental

  • Retirement

  • PTO

One (1) or more years of experience working in Medical Management (e.g., MDS role), Medical Review, Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience ...

New

Evolent

Physician Reviewer-Radiology (Part Time)

Madison, WI · On-site

$95 - $100/hr

  • Medical

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ...

Evolent

Physician Reviewer-Radiology (Full-Time)

Madison, WI · On-site

$95 - $96/hr

  • Medical

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ...

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Showing results 1-20

All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Madison, WI

Utilization Review Manager information

See Madison, WI salary details

$39.3K

$91.7K

$168.8K

How much do utilization review manager jobs pay per year?

As of Aug 13, 2026, the average yearly pay for utilization review manager in Madison, WI is $91,706.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,000.00 and $110,300.00 per year, depending on experience, location, and employer.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What are the key skills and qualifications needed to thrive as a utilization review manager?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
What are the most commonly searched types of Utilization Review jobs in Madison, WI? The most popular types of Utilization Review jobs in Madison, WI are:
What are popular job titles related to Utilization Review Manager jobs in Madison, WI? For Utilization Review Manager jobs in Madison, WI, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Madison, WI look for? The top searched job categories for Utilization Review Manager jobs in Madison, WI are:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Madison, WI as of June 2026, with employment types broken down into 3% As Needed, 56% Full Time, 38% Part Time, and 3% Temporary. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $91,706 per year, or $44.1 per hour.

Drug Utilization Review (DUR) Pharmacist - Remote

Pharmacy Careers

Madison, WI • On-site

Other

Posted 2 days ago

New

Job description

Remote DUR Pharmacist - Safe & Cost-Effective Medication Use | Work From Home
Analyze medication use patterns, apply clinical guidelines, and collaborate with providers - all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy clinical analysis and want to improve outcomes at scale.
Key Responsibilities

  • Conduct prospective, concurrent, and retrospective drug utilization reviews.
  • Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  • Identify potential drug interactions, therapeutic duplications, and inappropriate therapy.
  • Prepare recommendations for prescribers to optimize therapy and reduce risk.
  • Document reviews and ensure compliance with state, federal, and health-plan requirements.
  • Contribute to quality-improvement initiatives and pharmacy program development.
What You'll Bring
  • Education: PharmD or Bachelor of Pharmacy.
  • Licensure: Active U.S. pharmacist license.
  • Experience: Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail orientation, excellent written and verbal communication.
Why This Role?
  • Shape prescribing decisions that affect thousands of patients.
  • Build expertise in managed care and population-health pharmacy.
  • Many DUR roles offer hybrid or fully remote schedules.
  • Competitive salary, benefits, and career advancement.

About Us
We are a confidential healthcare partner providing managed-care pharmacy services nationwide. Our DUR pharmacists ensure medications are used safely, appropriately, and cost-effectively.
Apply Today
Advance your career in managed care - apply now for our Remote Drug Utilization Review Pharmacist opening.

Apply